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The latest and most progressive treatment advice from prostate cancer experts at the nation's top medical centers
For each of the nearly 200,000 Americans diagnosed with prostate cancer annually, the months following the diagnosis are a time of momentous decisions and enormous emotional strain. This book offers readers complete answers to all their questions about the best treatment options for fighting and beating prostate cancer. Bringing together the insights and expertise of 21 of the nation's top prostate cancer specialists from the Mayo Clinic, Harvard Medical School, Memorial Sloan-Kettering, the Seattle Prostate Institute, and other leading treatment centers, The Prostate Cancer Treatment Book provides:
What Good Is a Prostate, Anyway?
Ian M. Thompson, M.D.; J. Brantley Thrasher, M.D.; Mark A. Moyad, M.D., M.P.H.; John E. Sylvester, M.D.
Most people rarely—if ever—think about the prostate gland. They understand it's a male organ in the pelvic area, situated somewhere between the navel and testicles. They may be vaguely aware that it serves some purpose related to creating offspring. And they know that measuring the prostate specific antigen (PSA) level is an important annual blood test for many men. But the gland is tucked deep inside and it rarely causes trouble, so there's little incentive to take the time to learn about it.
But when the words prostate cancer are uttered, suddenly the prostate leaps to the forefront of consciousness and the race is on to gather as much information as possible, in as little time as possible.
So, that's where we begin. Chapter 1 helps you clear this first hurdle in conquering prostate cancer by explaining what the prostate gland is, what it does, and what can go wrong with it.
What is the prostate and what function does it serve?
The prostate is a conglomeration of tiny glands, ducts, and muscle tissue encased by fibrous tissue. It produces fluid that contains hormones and proteins to keep sperm alive after ejaculation as the sperm searches for an egg to fertilize.
The average size of a prostate is about 30 to 40 grams, about the size of a small lime or walnut. Its texture is firm. About one-third of the prostate is composed of muscular tissue, with the rest being glandular tissue.
As a man ages, his prostate often gets bigger, sometimes doubling or tripling in size. Although there is a lot of discussion about prostate enlargement in aging men and the uncomfortable symptoms that this can cause, it's important to remember that not all men experience prostate enlargement, and cancer is not responsible for this enlargement.
The prostate's zones include the transition, the central, the anterior, and the peripheral (see Figure 1.1).
The transition zone is the most interior part of the prostate; it immediately surrounds the urethra (the slender tube that carries urine away from the bladder and out of the body through the tip of the penis). The transition zone can begin to grow after age 40, with this noncancerous enlargement possibly leading to urinary difficulties.
The central zone is up near the bladder and is the seat of about one-third of the glands that make and secrete prostatic fluid. The central zone, similar to the transition zone, is generally the part of the prostate that grows after a man turns 40. Prostate cancer is unusual in the central zone and if it does develop, it tends to be a slower growing type of cancer.
The anterior zone (anterior means "front") is mostly muscle tissue. The peripheral zone is at the back of the gland and is the portion closest to the rectum. It contains most of the secretion-producing glands and is where prostate cancer usually develops.
Are there "right" and "left" glands, or are there "right" and "left" sides of one gland?
Physicians describe a right side and a left side, but in reality there is only a subtle demarcation between the two sides. Think of a plum. It's one fruit, but the small groove down the middle leaves the impression of two halves. That's similar to the prostate gland.
Where is the prostate, and what other important organs are near it?
If you measured how far the prostate is situated inside the pelvic area, it's about two inches from the perineum, which is the region of exterior skin and internal muscle between the anus and the scrotum. The gland sits just below the bladder and in front of the rectum (see Figure 1.2). Off the base of the prostate and behind the bladder are the two seminal vesicles, which produce most of the fluid that makes up the ejaculate.
What are the apex and the base of the prostate?
The base of the prostate is the wider part of the gland that nestles up to the bladder. The apex is the more pointed end of the gland that faces down toward the perineum.
How does the prostate work?
Just before ejaculation, sperm from the testicles is transported into the urethra by a long tube called the vas deferens. This sperm combines with fluid both from the seminal vesicles and the prostate, creating semen. The prostate and adjacent muscular contractions then propel the semen out of the urethra through the tip of the penis for ejaculation.
BPH and Prostatis
What is benign prostatic hyperplasia (BPH) and what causes it?
Benign prostatic hyperplasia is the medical term for noncancerous enlargement of the prostate. At about age 40, the transition and/or central portion of the prostate can begin to grow. As one or both of these areas enlarge, the growth can compress the part of the urethra that runs through the prostate (see Figure 1.3).
The prostate is sensitive to the normal male hormones (androgens) inside a man's body. The primary androgen, of course, is testosterone, and it's testosterone that seems to be partially responsible for BPH in older men.
What are the symptoms of BPH?
Depending on how the prostatic tissue grows, it may cause different symptoms in different men. However, the usual symptoms are more frequent urination, especially in the middle of the night. Also, the bladder may not feel completely empty, or there may be a need to push or strain because of a slow urinary stream. Another possible symptom is urgency (meaning a strong desire to urinate). Urgency occurs when the bladder gets the signal that it's full. If this is a very strong signal and a man cannot relieve himself quickly, it's possible to leak urine.
Is treatment of BPH always necessary?
No, not always. In fact, many men with BPH aren't bothered by symptoms at all. It could be that the onset of symptoms is so gradual or the symptoms are so minor that they don't adversely impact quality of life. For instance, a man may have to get up just once or twice a night and urinate only a bit more frequently during the day.
When symptoms progress to a point of interfering with usual daily activities—such as a man being unable to take a long car trip because he has to use a restroom frequently or he gets out of bed several times at night—then he'll probably seek treatment.
Can drugs treat BPH?
Yes. The three classes of medications most frequently used to treat BPH are alpha-blockers, 5-alpha-reductase inhibitors, and herbal supplements.
Alpha-blockers. These medications relax the smooth muscle tissue at the neck of the bladder and in the prostate, to let patients urinate more freely. These medications are very effective in improving symptoms, usually within days to weeks. Alpha-blockers are generally safe but sometimes can make patients dizzy or weak. Some alpha-blockers may also cause a slight decrease in blood pressure. A few patients can't take alpha-blockers because the drugs leave them feeling fatigued and drained.
5-alpha-reductase inhibitors. Finasteride (Proscar) and dutasteride (Avodart) are approved in the United States to treat BPH. These drugs block the conversion of testosterone into the more potent dihydrotestosterone. Used over three to six months, 5-alpha-reductase inhibitors shrink the prostate. In large clinical trials, the men who took these medication
Excerpted from The Prostate Cancer Treatment Book by Peter D. Grimm. Copyright © 2004 by Peter D. Grimm, John C. Blasko, and John E. Sylvester. Excerpted by permission of The McGraw-Hill Companies, Inc..
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|Part I||The Foundation|
|1.||What Good is a Prostate, Anyway?||3|
|2.||How is Heart Health Connected to Prostate Cancer Risk?||21|
|3.||How Do They Test for Prostate Cancer?||37|
|4.||What Part Do Spouses and Partners Play?||61|
|Part II||Treatment Options|
|5.||Is Watchful Waiting the Same as Doing Nothing?||69|
|6.||Should I Have My Prostate Removed?||75|
|7.||How Does External Beam Radiation Therapy Work?||93|
|8.||Brachytherapy for Prostate Cancer: Are Seeds the Way to Go?||113|
|9.||What Happens After the Implant? Side Effects and PSA||139|
|10.||Will I Have to Be on Hormones?||155|
|11.||What Happens if the Cancer Returns?||167|
|Part III||Other Important Considerations|
|12.||What Should I Ask My Doctor?||179|
|13.||How Do I Find the Best Doctor for Brachytherapy?||187|
|Appendix A||The Bottom Line||193|
|Appendix B||Prostate Cancer Resources||195|
|About the Seattle Prostate Institute||211|
Posted January 21, 2004
I wish this book had been available when I was diagnosed with prostate cancer in 2003. Like many men who suddenly learn they have prostate cancer, I had a thousand questions and spent countless hours searching the Internet and libraries for some answers. This newly-published guide will greatly reduce the emotional turmoil of men (and their loved ones) who are anxiously seeking information about prostate cancer and the choice of treatments to fight this life-threatening disease. This book has a unique question-and-answer format. The questions -- from patients just like me -- are answered by nearly two dozen doctors from all across the U.S. who are experienced, up-to-date experts in the diagnosis and treatment of prostate cancer. This impressive 224-page compilation is the creation of the Drs. Peter Grimm (no relation), John Blasko, and John Sylvester, principal physicians at the renown Seattle Prostate Institute, and pioneers of radioactive seed implants to combat prostate cancer. All the basics are covered in this book -- from PSAs to prostate biopsies -- as well as side-effects such as incontinence and sexual dysfunction during and after the various treatments, whether surgery, radiation or hormone therapy. Especially welcome (and difficult to find elsewhere) is information about the effects of certain vitamins, dietary supplements, and foods on the prostate in regard to cancer. A brief but very worthwhile chapter deals with the ways wives or partners can assist their men who are fighting prostate cancer. Also valuable in helping you find the best physician to treat you is a chapter entitled 'What Should I Ask My Doctor?' Data from scientific studies is included where meaningful, but you are not overwhelmed by statistics (which soon become dated because of ongoing improvements in prostate cancer treatments). This is the ideal and easy-to-read 'first' book for any man who learns he has prostate cancer. It's also perfect for anyone seeking information who is a family member or knows someone with prostate cancer. Also, I've personally found it of great use for knowing what to anticipate in the months and years ahead after my recent (and, so far, successful) treatment for prostate cancer.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted February 14, 2004
This is a must read for anyone who has been diagnosed with prostate cancer! I am a long time medical professional and I am here to tell you that not all Physicians offer you the best treatment for you but for their own pocket. That's right, for a lot of Physician's medicine is more about money than a your best interest. Read this book, they speak the truth and offer REAL answers about real concerns. Don't gamble with your health, put in the research for yourself and read this book.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.